In 1988, the General Assembly of the Presbyterian Church (U.S.A.) endorsed "Life Abundant:  Values, Choices and Health Care.  The Responsibility and Role of the Presbyterian Church (U.S.A.)."  Through "Life Abundant," the Assembly commented on the fundamental importance of health, noting: 

Good health — physical, mental, and spiritual — is both a God-given gift and a social good of special moral importance; one that derives its importance from our biblical and theological heritage and from its effect on the opportunities available to members of society.  Good health is a basic need and an essential purpose of human and societal development. 

The Assembly also remarked on equal access for all to appropriate and necessary care, pronouncing:

Every person must have affordable, quality health services.  Access should not be limited by income, ethnicity, or geography.  It is the proper function of all groups of society including government in their concern for justice to ensure equal access to health services.

(1988 Statement  — PC(USA), pp. 524-525, 529-530)

Unfortunately, not everyone in the United States is fortunate enough to have good health — and wide gaps exist in health care outcomes based on gender, race, ethnicity, education, income, geographical location, and other factors.  For example, in 2000, while nearly 8 percent of whites were considered to be in fair or poor health, nearly 13 percent of Hispanics/Latinos, nearly 14% of African Americans, and more than 17 percent of Native Americans were in fair or poor health. What other examples are there of health care disparities? Why are there racial and ethnic disparities, and what can be done to ensure equal access to health services — and to health outcomes?

Health Care Disparities

The overview for Healthy People 2010, 1 a federal government initiative by 2010 to increase quality and years of healthy life and to eliminate health disparities, lifts up powerful examples racial and ethnic disparities in health care.

For example:

• Though the nation's infant mortality rate is down, the infant death rate among African Americans is still more than double that of whites.
• The death rate from HIV/AIDS for African Americans is more than seven times that for whites.
• Hispanics living in the United States are almost twice as likely to die from diabetes as are non-Hispanic whites. 
• American Indians and Alaska Natives have disproportionately high death rates from unintentional injuries and suicide.

Though on average, Asian and Pacific Islanders have indicators of being one of the healthiest population groups in the United States, there is great diversity within this population group.  For example, women of Vietnamese origin suffer from cervical cancer at nearly five times the rate of white women.

Why are there disparities?

Certainly the issue of health care access is a factor.  In 2002, 20.2 percent of African Americans and 32.4 percent of Hispanics/Latinos were uninsured, compared to 11.7 percent of whites, according to the Alliance for Health Care Reform.  Economic status also accounts for some of the difference.  In 2001, more than half of Hispanics/Latinos, African Americans, and Native Americans were considered poor or near poor (household income less than $28, 256 for a family of three).  Only one-fourth of whites were below this income level. 

However, income and insurance status alone are not the only reasons for disparities based on race and ethnicity.  Unequal Treatment:  Confronting Racial and Ethnic Disparities in Health Care, 2 a report issued by the Institute of Medicine (IOM) in 2002, found that the root causes for these disparities are multifactorial.  Finding solutions to eliminate disparities requires an understanding of multiple causes.  The authors of Unequal Treatment noted,  The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, health care professionals, and patients. Minorities may experience a range of other barriers to accessing care, even when insured at the same level as whites, including barriers of language, geography, and cultural familiarity. 

Recommendations to Reduce and Eliminate Disparities 

The IOM's Unequal Treatment report makes a case for a comprehensive strategy to eliminate health care disparities by addressing numerous issues — including health care systems, the legal and regulatory contexts in which they operate, health care providers, and their patients.  To reduce disparities, the report calls on those in the health care field, and for society at large to raise awareness of the gaps in health care.  In addition, the report calls on society to understand the cultural and linguistic needs of patients 3 and calls on the U.S. Department of Health and Human Services to encourage health care plans and providers to collect, monitor, and report patient care data by racial and ethic group, in order to assess progress in eliminating disparities. For a complete list of IOM's recommendations, see page 3. 

Federal Legislation 

The Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus partnered to introduce the Healthcare Equality and Accountability Act (H.R. 3459/S.1833) to eliminate disparities.  Sponsored by Rep. Elijah Cummings (D-MD) in the House and Sen. Tom Daschle (D-SD) in the Senate, the bill would expand access to health insurance for children and legal immigrants, dismantle linguistic and cultural barriers, expand research into diseases like diabetes and asthma that disproportionately impact minorities, and encourage more students of color to become doctors, nurses, and dentists.   

In July, the Caucuses met in Miami for their second annual Tri-Caucus Minority Health Summit and focused on raising the issue of ethnic and racial health disparities, with a particular focus on immigrant health, HIV/AIDS, tobacco-related diseases, and obesity-related diseases, including Type-II diabetes.  No Congressional hearings have been held on this legislation, which has 103 co-sponsors in the House and 21 co-sponsors in the Senate.    

Take Action

What can you do to take action to help reduce and eliminate health care disparities?

Contact your Representative and Senators and urge them to act on the Recommendations of the Institute of Medicine's Unequal Treatment report.  Share a copy of the recommendations (found on page 3) with your Members of Congress, along with details of how health care disparities impact your community.

Host a discussion group at your church on the issue of health care disparities.  Consider using the following resources to prepare your discussion:

"Life Abundant:  Values, Choices and Health Care.  The Responsibility and Role of the Presbyterian Church (U.S.A.)" (available through Presbyterian Distribution Service.  See footnote for ordering information.)

Promoting National Standards for Culturally and Linguistically Appropriate Services (Click here for PC(USA) General Assembly Policy on CLAS Standards)

The Henry J. Kaiser Family Foundation and The Robert Wood Johnson Foundation's initiative, "Why The Difference?" provides helpful resources for planning a discussion.

Ask your health care provider or parish nurse about health care disparities.  Dialogue about IOM's Unequal Treatment recommendations.

Recommendations

Unequal Treatment:  Confronting Racial and Ethnic Disparities in Health Care (2002)

General Recommendations

• Increase awareness of racial and ethnic disparities in health care among the general public and key stakeholders.
• Increase health care providers' awareness of disparities.

Legal, Regulatory, and Policy Interventions

• Avoid fragmentation of health plans along socio-economic lines
• Strengthen the stability of patient-provider relationships in publicly funded health plans.
• Increase the proportion of underrepresented U.S. racial and ethnic minorities among health professionals.
• Apply the same managed care protections to publicly funded HMO enrollees that apply to private HMO enrollees.
• Provide greater resources to the U.S. DHHS Office for Civil Rights to enforce civil rights laws. 

Health Systems Interventions

• Promote the consistency and equity of care through the use of evidence-based guidelines.
• Structure payment systems to ensure an adequate supply of services to minority patients, and limit provider incentives that may promote disparities.
• Enhance patient-provided communication and trust by providing financial incentives for practices that reduce barriers and encourage evidence-based practice.
• Support the use of interpretation services where community need exists.
• Support the use of community health workers.
• Implement multidisciplinary treatment and preventive care teams.

Patient Education and Empowerment

• Implement patient education programs to increase patients' knowledge of how to best access care and participate in treatment decisions.

Cross-Cultural Education in the Health Professions

• Integrate cross-cultural education into the training of all current and future health professionals.

Data Collection and Monitoring

• Collect and report data on health care access and utilization by patients' race, ethnicity, socioeconomic status, and where possible, primary language.
• Include measures of racial and ethnic disparities in performance measurement.
• Monitor progress toward the elimination of health care disparities.
• Report racial and ethnic data by OMB categories, but use subpopulation groups where possible.

Research Needs

• Conduct further research to identify sources of racial and ethnic disparities and assess promising intervention strategies.
• Conduct research on ethical issues and other barriers to eliminating disparities.